DUAL‐energy computed tomography findings in a case of COVID‐19

Abstract

Background COVID‐19 pneumonia has lesions with a decreased blood flow. Dual‐energy computed tomography is suitable to elucidate the pathogenesis of COVID‐19 pneumonia because it highlights the blood flow changes in organs. We report the dual‐energy computed tomography findings of a successfully treated case of COVID‐19 pneumonia. Case Presentation An obese 49‐year‐old man with COVID‐19 pneumonia was transferred from another hospital on day 11 after onset of illness. Although he was hypoxemic (PaO 2 /FiO 2 = 100), tracheal intubation was not performed after anticipating difficulty in weaning from mechanical ventilation. Prone position therapy and nasal high flow therapy were administered, and the patient was discharged after his condition improved. Dual‐energy computed tomography was performed three times during hospitalization, and it revealed improvement in the blood flow defect, unlike plain computed tomography that did not show much improvement. Conclusion Dual‐energy computed tomography can assess perfusion in COVID‐19 pneumonia in real time and may be able to predict its severity.

Utility of dual‐energy computed tomography in the association of COVID‐19 pneumonia severity

“…Specifically, pulmonary perfusion is decreased in COVID-19 pneumonia and increased in atelectasis and bacterial pneumonia. 10,22 The perfusion distribution may help to determine whether the prone, right-sided, or left-sided position is more effective. Here, we present cases for which prone therapy was effective and non-effective.…”

“…Because DECT evaluates pulmonary perfusion, it can visually diagnose atelectasis and secondary bacterial pneumonia, both difficult to distinguish on plane CT. Specifically, pulmonary perfusion is decreased in COVID‐19 pneumonia and increased in atelectasis and bacterial pneumonia 10,22 . The perfusion distribution may help to determine whether the prone, right‐sided, or left‐sided position is more effective.…”

“…A medium-soft convolution kernel with iterative reconstruction (Q33 iterative strength 2) was used to produce all the images. 10 Plane CT was also taken during DECT imaging (Fig. 1A).…”

“…8 DECT has been suggested to be effective in visualizing the etiology of COVID-19 pneumonia because of its ability to highlight changes in organ blood flow. 9,10 Although plane computed tomography (CT) has been widely performed in the clinical management of COVID-19 pneumonia, DECT is not currently applied as a routine test.…”

“…Dual‐energy computed tomography (DECT) correlates with lung scintigraphy and allows for the assessment of pulmonary perfusion in a manner that is suitable for urgent examination 8 . DECT has been suggested to be effective in visualizing the etiology of COVID‐19 pneumonia because of its ability to highlight changes in organ blood flow 9,10 …”